Question: My husband has been in a nursing facility for several months receiving Chronic Medicaid. He is now ready to come home and receive home care Medicaid. How much of his income can he keep when he returns home?
Answer: Once your husband returns home, his Medicaid status will convert from Chronic Medicaid (nursing home coverage) to Community Medicaid (home care coverage). The income allowances will change due to the modification in coverage. When someone receives Medicaid benefits in a nursing facility, the monthly income goes to the facility. This offsets the cost of care paid by Medicaid. When someone is discharged home, the income allowance changes so that the individual can pay expenses in the community.
For 2021, a Community Medicaid applicant can keep $904.00 monthly and remain eligible for these long-term care services. Medicaid requires the applicant’s excess income be paid to the Department of Social Services as a contribution toward the cost of care. Without proper planning, any amount over the $904.00 is considered “excess income.” Most individuals rely on their income to cover monthly expenses and cannot subsist on $904 per month. They would be unable to return home if they could not retain their full income. The good news is that there are planning techniques that let the recipient receive an additional allowance or protect excess income.
What Are the Requirements for Long Term Care at Home?
Many people are unaware of the special income standard for Chronic Medicaid recipients discharged from a nursing home to receive long term care at home. As long as a Medicaid recipient meets certain requirements, they are entitled to an extra housing allowance when they move back to the community. These requirements are that the individual (a) is over the age of 18; (b) spent at least 30 days in a nursing home; (c) had Medicaid pay towards the cost of care at the nursing home; (d) has a housing expense; and (e) is enrolled in a managed long term care company (MLTC). For Long Island the allowance is $1,393.00. For NYC the allowance is $1,535.00. This increased allowance from $904.00 allows individuals to transition from the nursing home to the community and pay their housing expenses.
Pooled Income Trusts for Residents of New York
In New York, a Pooled Income Trust can also protect excess income (any amount over the $904.00 in 2021). This option is available to any Community Medicaid recipient regardless if they were discharged from a nursing home. Each month the Community Medicaid recipient can deposit excess income into the Pooled Income Trust and continue receiving Medicaid. The recipient then submits bills to the trust to pay household expenses for his or her benefit. There are several Pooled Income Trust companies operating in the State of New York with varying fee schedules.
Legal Help for Transitioning from Chronic to Community Medicaid
The transition from a nursing facility back to the community can be difficult to navigate. Proper planning can ensure that the Medicaid recipient keeps an income stream to pay necessary expenses. After all, most seniors prefer to age in place. An experienced Medicaid attorney can explain the ins and outs of Medicaid eligibility to make sure that your loved one ages in place as safely as possible.